CPT 59855 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures for Maternity Care and Delivery |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • GC - Service performed by resident under supervision • AG - Primary physician |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 59855 |
National average reimbursement for CPT 59855 by major payers:
$527.35
$556.05
$562.30
$687.78
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 59855 | ||||||
United | 59855 | $900.00 | 1538167978 - VALLEY SURGICAL CENTER LTD, VALLEY SURGERY CENTER | 300035229 - (OH) VALLEY SURGICAL CENTER LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $750.00 | 1205076593 - HEALTHCARE PARTNERS ASC-HB, LLC, TALBERT SURGICAL ASSOCIATES, LLC | 264247365 - (CA) HEALTHCARE PARTNERS ASCHB LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $1000.00 | 1881001212 - AMBULATORY SURGICAL CENTER AT BASKING RIDGE | 833879253 - (NJ) LIBERTY CORNER SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $110.00 | 1851531248 - LASER SURGERY HOLDING COMPANY, LTD | 550882748 - (AZ) LASER SURGERY HOLDING COMPANY LT | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $560.00 | 1508862160 - TRIAD SURGERY CENTER LLC, TRIAD EYE MEDICAL CLINIC AND CATARACT INSTITUTE PLLC | 465002052 - (OK) TRIAD EYE INSTITUTE, PLLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $503.00 | 1326508045 - EYE SURGERY CENTER OF LENOIR CITY, LLC | 815283231 - (TN) EYE SURGERY CENTER OF LENOIR CITY LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $906.00 | 1659574283 - PROVIDENCE VENTURES, LLC, BONE AND JOINT SURGERY CENTER OF NOVI | 161704029 - (MI) PROVIDENCE VENTURES, LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $200.00 | 1043375702 - HAZLETON ENDOSCOPY CENTER, INC. | 233074102 - (PA) HAZLETON ENDOSCOPY CENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $1964.00 | 1003144353 - PIEDMONT WEST AMBULATORY SURGERY CENTER | 264422348 - (GA) PIEDMONT WEST AMBULATORY SURGERY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $558.00 | 1811168164 - UROLOGIC SPECIALISTS OF NEW ENGLAND LLC | 208951188 - (RI) UROLOGIC SPECIALISTS OF NEW ENGLAND, LLC | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $492.00 | 1346698602 - MARION EYE SURGERY CENTER LLC | 263644916 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $238.00 | 1235239054 - MAIN LINE PA ENDOSCOPY ASC LP, MAIN LINE ENDOSCOPY CENTER BALA CYNWYD | 205301211 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $410.00 | 1932856945 - UPPER VALLEY DIALYSIS ACCESS CENTER, LLC | 863328769 - (TX) UPPER VALLEY DIALYSIS ACCESS CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $2732.00 | 1538122569 - CENTENNIAL SURGERY CENTER LP | 621624530 - (TN) CENTENNIAL SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59855 | $800.00 | 1629045133 - MONTICELLO COMMUNITY SURGERY CENTER, LLC, UVA HEALTH SURGICAL CARE RIVERSIDE | 113656095 - (VA) MONTICELLO COMMUNITY SURGERY | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 59855 vs. Other Surgical Procedures for Maternity Care and Delivery Codes
The CPT 59855 code is part of the Surgery services used for Surgical Procedures for Maternity Care and Delivery. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 59855 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 59855-CPT | Moderate | Induced Abortion, By 1 Or More Vaginal Suppositories (Eg, Prostaglandin) With Or Without Cervical Dilation (Eg, Laminaria), Including Hospital Admission And Visits, Delivery Of Fetus And Secundines; |
| 59856-CPT | Moderate | Induced Abortion, By 1 Or More Vaginal Suppositories (Eg, Prostaglandin) With Or Without Cervical Dilation (Eg, Laminaria), Including Hospital Admission And Visits, Delivery Of Fetus And Secundines; With Dilation And Curettage And/Or Evacuation |
| 59857-CPT | Moderate | Induced Abortion, By 1 Or More Vaginal Suppositories (Eg, Prostaglandin) With Or Without Cervical Dilation (Eg, Laminaria), Including Hospital Admission And Visits, Delivery Of Fetus And Secundines; With Hysterotomy (Failed Medical Evacuation) |
| 59866-CPT | Moderate | Multifetal Pregnancy Reduction(S) (Mpr) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 59855. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 59855 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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